• category A: easily transmitted person to person, requires special tx,high mortality.
• category B: moderately easy to dissiminate, low mortality, moderate morbid.
• category C: emerging pathogens, potential for future use.

gram postive bacillus that forms spores & is found in soil worlwide. Human usually infected by contact wit infected animals or animal products.

There is NO person to person transmission of Anthrax.

Concerning Cutaneous Anthrax (most common form-95%), what would the progression of the papule be?

• small papule
• ulcer surrounded by vessicles
• painless eschar with edema.

A positive test indicates exposure only, it does not dx infection. It is a tool for epidemiology only.

For inhalation or cutaneous Anthrax with systemic involvement:

• cipro 400mg iv q 12h or doxy 100 mg PO IV q 12h.  combine with one:  rifampin, vanco, PCN, clinida
• TREAT FOR 60 DAYS

What is the treatment for uncomplicated cutaneous Anthrax?

Cipro 500mg PO Bid, or Doxy 100mg BID

kids or breastfeeding Moms: amoxicillin

levoquin OK of 18y or >

Treat for 60 days

• Bubonic: cutaneous form, flea bite, flu like s/s, buboes, andenopathy.
• Pneumonic (most likely bio weapon): flu like s/s pneumonia progresses to hypoxemia, cyanossis & hemoptysis.

1. pt inhales organisms
2. 2-3d later sudden onset of flu like s/s
3. 24h later.......pneumonia w/productive cough, bilat. infiltrates, cyanosis.
4. ARDS, DIC
5. endotoxemia
6. respiratory failure, circulatory collapse.

IV aminio glycoside and IV Doxy

or

Cipro

True or False

No diagnostic rapid test exists for the plague.

True

gram stain of body fluids may reveal gram negative organism & BC should be + in 48h.

• variable incubation 2-21d
• flu like s/s with high fever
• increased vascular permeabilty causes hemorrhage in GI tract & mucous membrane.
• petechia or ecchymotic rash
• edema, hypotension.

• supportive tx
• IV ribabirin used for Lassa
• vaccines under development
• prophylaxix with ribabirin may be useful
• contact and respiratory precautions
• mortality rate 90% for Ebola.

• caused by variola virus
• has characteristic skin legionns
• about 30% mortality in unvaccinated
• last known natural case Somolia 1977
• any Dx will be considered bioterrorism

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Maclular (flat, red) rash 2-3d after flu s/s. starts on face, forearms, hands and palms and soles. evolves into tense vesicles.

• can be aerosolized
• highly contageous
• no effective tx
• vaccination ceased 1972
• remains stable in the envirnment

• virus inhaled or deposited on membranes
• goes to lymph nodes & incubates 7-17d
• release into blood stream: flu like s/s
• rash begins 2-3d later
• death due to toxemia of viral antigens and circulating immune complexes.

In Smallpox illness develops before the rash, in chickenpox it occurs after the rash.

No effective tx.

Vaccinate all potential contacts within 3-4d

What are some facts about the Smallpox vaccine?

• Virus sheds from vaccine site for up to 6w.
• Shedding can infect household contacts.
• encephalitis, severe vaccinia, anaphylaxis, Stevens-Johnson have been reported S/E.
• Auto innoculation.

True or False

Sarin gas is used for mass infection while Ricin (a derivative of the castor been plant) is used for infecting one individual at a time.